What is Medicare?

1. What is Medicare? Karen Mayse, North Central-Flint Hills Area Agency on Aging • Health insurance for three groups of people • 65 and older • Under 65 with certain disabilities • Any age with End-Stage Renal Disease (ESRD) • Administration • Centers for Medicare & Medicaid Services (CMS) • Enrollment • Social Security Administration (SSA) for most • Railroad Retirement Board (RRB) railroad retirees Getting Started

2. The Four Parts of Medicare Getting Started

3. How to Enroll in Medicare • Enrollment is not automatic for everyone • Enroll with Social Security • Visit local office • Call 1-800-772-1213 • Online at socialsecurity.gov • If retired from Railroad enroll with RRB • Call your local RRB office or 1‑877‑772‑5772 Getting Started

4. Decision Should I keep/sign up for Part B? • If you do NOT have coverage from active employment • Yours or your spouses • Delaying Part B may mean • Higher premiums • Paying for your health care out-of-pocket • If you do have coverage through active employment • No penalty if you enroll while you have coverage or within 8 months of losing coverage Probably Maybe Not Getting Started

5. *Plan F has a high-deductible option ** Plans K and L have out-of-pocket limits of $4,640 and $2,320 respectively Getting Started

6. Part C – Medicare Advantage • Health plan options approved by Medicare • Run by private companies • Medicare pays amount for each member’s care • Another way to get Medicare coverage • Part of the Medicare program Getting Started

7. DecisionDo I want to join a Medicare Advantage Plan? • Consider • Most offer comprehensive coverage • You must have A & B, most plans include D • May require you to use network doctors or hospitals • You must pay monthly premium to plan – premium may change yearly • May need a referral to see a specialist • Can only join/leave plan during certain periods • Doesn’t work with Medigappolicies Getting Started

8. Part D – Medicare Prescription Drug Coverage • Available for all people with Medicare • Provided through • Medicare Prescription Drug Plans • Medicare Advantage Plans • Other Medicare plans • Must include range of drugs in each category Getting Started

9. Joining a Part D Plan • Can join during 7 month initial enrollment period • Can join during annual fall open enrollment • October 15 – December 7 • Coverage starts January 1 • Can join during other special times Getting Started

10. DecisionShould I enroll in a Part D plan? • Consider • Do you have creditable drug coverage? • Coverage as good as Medicare’s • For example through an employer plan • Will that coverage end when you retire? • You may pay a penalty if you don’t take Part D when first eligible unless you have creditable coverage Getting Started

11. DecisionHow do I choose a Part D plan? • To shop: • Plan Finder tool at www.medicare.gov • Call for SHICK help to compare plans • 866-457-2364 • Call 1-800-MEDICARE • To enroll: • Enroll at www.medicare.gov • Enroll on the plan’s Web site • Call the plan • Complete a paper application • Call 1-800-MEDICARE (1-800-633-4227) Getting Started

12. What help is there for people with limited income and resources? • Medicaid • Extra Help • Medicare Savings Programs Getting Started

13. What is Medicaid? • Federal-state health insurance program • For people with limited income and resources • Certain people with disabilities • Most costs covered for Medicare/Medicaid • Called “dually eligible” • Eligibility determined by state • Application processes and benefits vary • State office Social & Rehabilitation Services (SRS) • Apply if you MIGHT qualify Getting Started

14. What is Extra Help? • Help paying prescription drug costs • Social Security or SRS makes determination • Some groups automatically qualify • People with Medicare and Medicaid • Supplemental Security Income (SSI) only • Medicare Savings Programs • You or someone on your behalf can apply Getting Started

15. What are Medicare Savings Programs? • Help from Medicaid paying Medicare costs • Pay Medicare premiums • May pay Medicare deductibles and coinsurance • Income/resource guidelines • Income amounts change each year Getting Started

16. More Information • Medicare & You Handbook • www.medicare.gov • Other CMS publications • Call a SHICK Counselor at 866-457-2364 • 1-800-MEDICARE Getting Started

17. Was this presentation helpful? WE ARE ALWAYS LOOKING FOR A FEW GOOD VOLUNTEERS! Please ask me for details. Getting Started

18. SHICK Disclaimer This set of SHICK Training materials is not a legal document. The official Medicare program provisions are contained in the relevant laws, regulations, and rulings. Getting Started